a Department of Pediatrics, Divisions of Neonatal-Perinatal Medicine
c Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
b Department of Biostatistics, Children's Medical Center, Dallas, Texas
OBJECTIVE. Ductus arteriosus (DA) closure occurs within 96 hours in >95% of neonates >1500 g in birth weight (BW). The prevalence and postnatal age of spontaneous ductal closure in neonates
1000 g in BW (extremely low birth weight [ELBW] neonates) remain unclear, as does the incidence of failure to close with indomethacin. Therefore, we prospectively examined the prevalence, postnatal age, and clinical variables associated with spontaneous DA closure, occurrence of persistent patent DA, and indomethacin failure in ELBW neonates.
METHODS. Neonates delivered at Parkland Memorial Hospital from February 2001 through December 2003 were studied. Those with congenital heart defects or death <10 days postnatally were excluded. Echocardiograms were performed 48 to 72 hours postnatal and every 48 hours until 10 days postnatally.
RESULTS. We studied 122 neonates with BW of 794 ± 118 (SD) g and estimated gestational age (EGA) of 26 ± 2 weeks. Spontaneous permanent DA closure occurred in 42 (34%) neonates at 4.3 ± 2 days postnatally, with 100% closure by 8 days. These neonates were more mature, less likely to have received antenatal steroids or have hyaline membrane disease (HMD; 52% vs 79%), and more likely to be growth restricted (31% vs 5%) and delivered of hypertensive women. Using regression analysis, EGA and absence of antenatal steroids and HMD predicted ductal closure. Ten (8%) neonates with early DA closure reopened and required medical/surgical closure. Eighty neonates had persistent patent DA; 7 were surgically ligated, and 5 remained asymptomatic, with 4 of 5 closing after 10 days postnatally. Sixty-eight (85%) received indomethacin at 6.2 ± 4 days postnatally; 41% failed therapy and had no distinguishing characteristics.
CONCLUSIONS. Spontaneous permanent DA closure occurs in >34% of ELBW neonates and is predicted by variables related to maturation, for example, EGA and an absence of HMD, whereas indomethacin failure could not be predicated.
Key Words: gestational age extremely low birth weight indomethacin therapy chronic lung disease fluid therapy
Abbreviations: DAductus arteriosus BWbirth weight pPDApersistent patent ductus arteriosus EGAestimated gestational age HMDhyaline membrane disease ELBWextremely low birth weight PDApatent ductus arteriosus ECHOechocardiogram CLDchronic lung disease ORodds ratio CIconfidence interval SGAsmall for gestational age AGAappropriate for gestational age
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